Maternal Health

K, Ayesha and K, Adnan. (2013). Using Demand-Side Financing in reproductive Health.Research and Development Solutions, Policy Brief Series, 34.
This brief discusses the role and challenges of Social safety nets (SSN) and Demand Side Financing (DSF) to help marginalized households and to promote positive reproductive health (RH) behaviors in them. Social safety nets and demand side financing can subsidize the high costs and facilitate uptake of family planning and reproductive health services for the marginalized, allowing the government (or other funders) to help overcome both demand side (lack of recognition of the value of services) and supply side (lack of availability or access to services) to providing women with reproductive health services. Until now most DSF schemes are project based with limited sustainability. Since behavioral change requires time, DSF schemes for short durations do not guarantee high impact. Thus, long-term sustainability needs to be built into programs. Furthermore, in order to provide health services to the poorest, large scale up of FP and RH servicesusing a DSF model must be consideredand it must be ensured that facility births in rural locations are ideally suited to a DSF scheme. In this case the government can develop vouchers that could be redeemed by private providers.

K, Ayesha and K, Adnan. (2013).Comparative Review of the Reproductive Health Sector: Strategies of Punjab and Khyber-Pakhtunkhwa. Research and Development Solutions, Policy Brief Series, 38.
This policy brief compares the reproductive health components in the health sector strategy for Punjab and Khyber Pakhtunkhwa (KP) and reviews the respective importance given to priorities assigned to different strategies and suggest recommendations for the Government and Donors. Both policies have heavily prioritized towards the public sector as a means to provide healthcare and make little distinction between provision of preventive health services such as immunization, family planning and safe birthing that improve the health of communities and provision of medical care that are often desired by communities but contribute less towards improving health status of communities. Thus, the policy brief recommends that beyond structural reforms, infrastructure and service delivery, the public sector must stimulate demand for preventive services such as safe birthing, vaccination and family planning; leaving the private sector to provide medical care. Furthermore, effective implementation of these comprehensive strategies requires a monitoring plan to measure and report performance, targets and operations. These then must be linked with performance based rewards and consequences. Brief 38 – Lessons from Health Strategies of Punjab and KPK.pdf

Bhutta et al. (2011). Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial. The Lancet, 377(9763), 403-412.
This study is a randomized cluster trial in rural Sindh which seeks to test the effectiveness of a package of preventive maternal and newborn care strategies in rural Pakistan, delivered through LHWs in collaboration with voluntary community health committees (CHCs) and Dais. The intervention consisted of training of LHWs and Dais and promotion of liaison between them, together with facilitation of the creation of voluntary CHCs to promote maternal and newborn care in their villages. Despite low coverage and high complexity, the intervention was associated with significant reductions in stillbirths and neonatal mortality. However, in view of the geographical boundaries, the issue of contamination and diffusion between intervention and control clusters should be considered. Furthermore, data for household practices are based on mothers’ verbal reports of what they did, rather than observed behaviours. Despite these limitations and the known reduction in effectiveness when scaling up from efficacy trials,thetrial provides encouragement that a public sector programme promoting preventive maternal and newborn care can lead to behavioural change and careseeking for mothers during pregnancy and childbirth with resultant health benefits.

Khan, Y. P., Bhutta, S. Z., Munim, S., &Bhutta, Z. A. (2009). Maternal health and survival in Pakistan: issues and options. J Obstet Gynaecol Can, 31(10), 920-929.
This paper looks at the problem of maternal mortality within the context of the larger issue of women’s health and health-related development of Pakistan. According to the paper, most maternal deaths are attributed to delays in getting medical care during obstetric complications. The first delay is partly due to household constraints, i.e., ignorance on the part of women’s families and birth attendants (usually traditional midwives) that delays the decision to seek medical care. The second delay occurs, when precious time is lost in transporting women to hospitals because of the lack of telephones and regular ambulance services. The third delay occurs at the hospital and is largely due to the unavailability of trained staff, a lack of supplies and equipment, and poorly organized emergency services. Thus, the paper postulates that in order to overcome these obstacles to maternal health, delivering currently available and potential interventions, at pragmatic and universal levels of coverage, could prevent a large proportion ofmaternal deaths in both primary care settings and referral facilities. However, the prerequisites for scaling up such interventions are investments in the public sector health system and innovative financing strategies to provide incentives for quality care and public-private partnerships.

Siddiqi, S., Haq, I. U., Ghaffar, A., Akhtar, T., &Mahaini, R. (2004). Pakistan’s maternal and child health policy: analysis, lessons and the way forward. Health policy, 69(1), 117-130.
This review analyzes Pakistan’s maternal and child health and family planning (FP) policy over the last decade, identifying strengths and weaknesses and factors underlying them. It broadly covers the period 1990–2002 and analyzes the last three health policies as well as the major national programs on MCH/FP during this period. The study demonstrates that institutional capacity and good governance is vital in translating policies into effective services. When this capacity is inadequate and governance poor, increased resource allocation even to the right programs, may lead to little actual provision of services. Moreover, frequent policy announcement sends inappropriate and confusing signals to the health managers and providers and weakens on-going implementation. Thus, the study recommends that there is a need for a Comprehensive MCH Framework comprising of an outline of a long term vision and objectives in line with MDGs. Furthermore, there is need to address gaps in MCH programs through effective programs to address nutritional deficiencies; access to good quality EmOC and referral services in the rural and hard to reach areas and emphasis on reducing neonatal and perinatal mortality. However, these measures need to be sustainable to be affective.

Jalil, F. (2004). Perinatal health in Pakistan: a review of the current situation. ActaPaediatrica, 93(10), 1273-1279.
Pakistan is likely to fail to achieve the Millennium Development Goals (MDGs) regarding child survival because of persistently high perinatal and neonatal mortality. Thus, this paper reviews perinatal/newborn health in Pakistan to understand its current status. According to the paper, perinatal and neonatal health is influenced by care practices in the communities, at the home level. A vast majority of neonatal deaths also occur at home, and very often the families do not seek medical help for the mother and the new- born during illness in the traditional 40 days of confinement. However, one intervention carried out in Lahore, showed that low cost care practices could change the indicators for perinatal and neonatal death. These practices include literacy and skill-based training of traditional birth attendants (TBAs), including the use of a Safe Delivery Kit; health education and counselling of mothers, families, TBAs and school teachers in breastfeeding, nutrition, child care and in utilizing health services; and promotion of basic adult female literacy. While the paper describes a number of ongoing health programmes in the country, it postulates that the impact is slow and disappointing. However, it proposes that even today, without additional input, the programme activities that can be implemented include those related to training and information provision.